Diagnostic accuracy of integrated 18F-FDG PET/CT for restaging patients with malignant germ cell tumours

P. Sharma, T. K. Jain, G. K. Parida, S. Karunanithi, C. Patel, A. Sharma, S. Thulkar, P. K. Julka, C. Bal, R. Kumar

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22 Scopus citations


Objective: Evaluation of utility of fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) for restaging patients with primary malignant germ cell tumours (GCTs).

Methods: Data of 92 patients (age, 31.94±10.1 years; male/ female, 86/6) with histopathologically confirmed malignant GCTs (gonadal, 88; mediastinal, 4; seminomatous, 47 and non-seminomatous, 45) who underwent 18F-FDG PET/CT for restaging (suspected recurrence/post-therapy evaluation) were retrospectively analysed. Two experienced nuclear medicine physicians reviewed the PET/CT images in consensus, qualitatively and semi-quantitatively [maximum standardized uptake value (SUVmax)]. Histopathology (if available) and clinical/imaging/biochemical follow-up (minimum of 6 months) were employed as the reference standard.

Results: 18F-FDG PET/CT was interpreted as positive in 59 and negative in 33 patients. Local disease was seen in 5, nodal disease in 50 and distant metastasis in 22 patients. PET/CT was true positive in 49, false positive in 10, true negative in 30 and false negative in 3 patients. 18F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 94.2%, 75.0%, 83.0%, 90.9% and 85.8% overall; 90.0%, 74.0%, 72.0%, 90.9% and 80.8% in seminomatous GCT; and 96.8%, 76.9%, 91.1%, 90.9% and 91.1% in non-seminomatous GCT, respectively. Difference in PET/CT accuracy for seminomatous and non-seminomatous GCTs was not significant (p50.263). PET/CT demonstrated disease in 13 patients with negative/equivocal conventional imaging findings and in 9 patients with normal tumour markers. No site- or histology-based difference was seen in SUVmax.

Conclusion: 18F-FDG PET/CT demonstrates high diagnostic accuracy for restaging patients with malignant GCTs. It has comparable diagnostic performance in both seminomatous and non-seminomatous malignant GCTs.

Advances in knowledge: The present article demonstrates high diagnostic accuracy of 18F-FDG PET/CT for restaging both seminomatous and non-seminomatous malignant GCTs in a large patient population.

Original languageEnglish
Article number20140263
JournalBritish Journal of Radiology
Issue number1040
StatePublished - 1 Aug 2014
Externally publishedYes


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